Features

The UCLA Heart Transplant Team Doesn't Miss a Beat

A specialty where every second counts

The helicopter is flying back to UCLA just in time, and aboard is a surgeon, a preservationist — and a human heart. One of the roles of Stephanie Fraschilla, RN, MSN, CCTC, as the heart/lung transplant coordinator at the Ronald Reagan UCLA Medical Center is to arrange the arrival of the donor’s heart, and it must be done with precision. The heart must be there as soon as the recipient’s chest is opened.

“You have to drop what you are doing,” she said. “You have to love it to do it.”

Fraschilla coordinates with a plethora of people: the cardiothoracic surgeon, the cardiologist, perfusionists, anesthesiologists, the transplant recipient, admissions, bed control, the emergency department, the procurement team, the operating room charge nurse, the cardiothoracic intensive care unit and the transportation company.

She has to time it all perfectly while hoping nothing unexpected comes up — such as inclement weather or traffic.“It’s like an orchestra,” Fraschilla said, “and I’m the conductor.” Making her work even more remarkable, the donor’s heart may still be beating during transport.

"We Get Creative”

UCLA’s heart transplant team is currently leading a national clinical study where the donor’s heart is kept beating during transport using an experimental organ-preservation system instead of being placed in an icebox. This may improve the function of the heart, aid with tissue matching, and may enable the organ to be transported longer distances. The technique requires special monitoring devices during transportation.

Fraschilla wanted to work with the Heart Transplant Program at UCLA because she was inspired by a nurse named Rocky, a legend who had been there since the birth of the program in 1984. Since then, UCLA has done more than 1,800 heart transplants on adults and pediatrics. Fraschilla calls them a “well-greased machine.” They certainly are. In November 2010, they received an award for being the best heart transplant program in the nation from the Health Resources and Services Administration.

Caron Burch, RN, MSN, FNP, CCTC, manager of the Heart/Lung Transplant Program at UCLA, explained they won the award because of their high donor transplant rates and low waitlist mortality rates; they try to keep the wait for organs as short as possible.

“We do everything we can,” Burch said. “We have an outstanding team.” They use helicopters, fixed-wing aircraft, ground transportation — anything they can to get the organ transported efficiently. Burch once even contacted the Air Force, but didn’t make it past the Pentagon.

“We get creative on the job,” Fraschilla said. “We do what we have to in order to make things happen.”

"I Couldn't Sleep"

Burch manages not only the heart and lung transplant coordinators, but also the Ventricular Assist Device (VAD) Program and still finds time to act as pre-pediatric heart transplant coordinator, attend a handful of meetings, and train new nurses — such as Michelle Ranheim.Ranheim, RN, BSN, joined the team a year ago after working in the coronary care unit for five years. She is taking on Burch’s role as pre-pediatric heart transplant coordinator.

“I feel like I’m finally leaving the adjustment period,” Ranheim said. Burch agreed that it takes about a year to feel comfortable.“My first on-call shift, I couldn’t sleep. I was staring at the pager waiting for it to go off,” Ranheim said, laughing. “I ended up getting nine organ offers.”

Ranheim talked about the stress of being on-call. When a call about an organ comes in, there is a short one-hour window to respond to the offer. The heart transplant coordinators take turns managing this duty so that someone is always available. “Yes, I had to put my social life on hold,” Ranheim said. “I was just working and sleeping.”

Ranheim openly thanked and praised her boss Burch for helping her move into her new role. Burch and Fraschilla, who have worked together for 13 years and call themselves “weathered,” teased Ranheim for her noted perkiness. The nurses had a friendly ease about them and an observable camaraderie. Although it’s challenging to find the time, they get together with each other outside of work.

“We’re not a unit, we’re a team,” Burch said. “We have known each other for years.” Ranheim believes UCLA’s excellence results from brilliant nurses and physicians. “People don’t leave here,” she said with a smile, “they are like dinosaurs.”

For nurses interested in the specialty of transplant nursing, Burch recommends getting telemetry experience to become familiar with discharges, and coronary intensive care experience to become familiar with transplant patients. It is also very important to be knowledgeable about hemodynamics. The trio laughed about a nurse who once referred to ejection fraction as “ejector fraction.” “When you are waking up surgeons at 3 a.m., they expect us to know what we are talking about,” Ranheim said.

“It’s Worth the Drive”

In addition to doing the actual coordination of heart transplants, the nurses have a big role in patient education, especially about medication. Nurses visit their patients pre- and post-transplant, and are available to them whenever they have a question.

Jennifer Rodriguez, 22, appreciates the value of the heart transplant coordinators. After being diagnosed with cardiac myopathy and going into cardiac arrest, Rodriguez was put on the heart transplant waiting list. She was placed on a VAD, and was able to wait at home. After a month, she was matched to a new heart and had a transplant on February 24, 2011.

“I feel way better. I am glad I went through this,” Rodriguez said. “I no longer feel dizzy and confused like I did before.” The rosy-cheeked and smiling Rodriguez explained how the nurses taught her everything to keep her heart healthy, helped her understand her medications, and regularly check in with her to make sure she is doing well. She now wants to go back to school.

John Doughty, 67, a retired diesel truck mechanic and grandfather of five, also appreciates the heart transplant coordinators. “I’ve learned you don’t go very far without them,” Doughty said with a sparkle in his blue eyes. Doughty chooses to drive to UCLA all the way from Santa Maria because of his physician’s recommendation. “I don’t know how many hospitals I passed on the way,” Doughty said, “but, it’s worth every bit of the drive.”

At the time of his interview, Doughty had been on the waiting list for a heart transplant for about 22 days. Like Rodriguez, he was placed on a VAD and discharged home. Doughty showed off the device, which looks like a black fanny pack, and explained simply how it is attached to his heart. “It really made a difference,” Doughty said.

Doughty requires very careful monitoring during his transplant wait. He explained he has his blood drawn weekly, and even a one-pound weight fluctuation is investigated. He can contact Ranheim any time he has a question, even for a mechanical question about the VAD. She had already spent some time explaining the transplant process and medications to him and his family. “My family felt pretty good after she was done talking,” he added.

“Adrenaline Rush”

Ranheim enjoys becoming really close to the patients and being a part of the success of a transplant. “I still keep in touch with some patients,” she said. “It’s rewarding to become such a big part of their life.” Fraschilla even had a 30-year old transplant patient name their baby after her. “I was shocked; I couldn’t believe it,” she said smiling. “I call her my little Stephanie. They bring her to see me; she’s like my daughter.”

But with the highs, there are also lows. Of course, not every patient on the waiting list gets an organ in time. “We know everything about their life,” Burch said. “When we lose them, it’s tough on us.” Burch reflected upon the many poignant moments this job has brought her. “What we do is pretty amazing,” she said. “The patients are on the brink of death before transplant, then post-transplant they are normal healthy people again.”

Fraschilla and Burch continue to work hard and somehow don’t get burned out with what they do; Fraschilla tries to get all the sleep she can, while Burch takes her stress out during a vigorous swim.

“Every time I hear a helicopter come in, I get an adrenaline rush,” Burch said. “If I lose that feeling, then I need to get out of this job.”

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Daria Waszak, RN, MSN, CEN, COHN-S, is a freelance writer with a variety of clinical and administrative nursing experience.